Posts filed under ‘Profilaxis Antibiótica en Cirugía – PAC’

Pseudomonas Prosthetic Joint Infections: A Review of 102 Episodes.

Journal of Bone and Joint Infection June 4, 2016 V.1 P.25-30.

Shah NB1, Osmon DR1, Steckelberg JM1, Sierra RJ2, Walker RC1, Tande AJ1, Berbari EF1.

Author information

1 Department of Internal Medicine and Division of Infectious Disease, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

Abstract

Background: The outcome of patients with Pseudomonas prosthetic joint infection (PS PJI) has not been well studied. The aim of this retrospective cohort study was to assess the outcome of patients with Pseudomonas PJI and to review risk factors associated with failure of therapy. Methods: Between 1/1969 and 12/2012, 102 episodes of PS PJI in 91 patients were identified. Results: The mean age at the time of diagnosis was 67.4 years; forty three percent had knee involvement. Over 40 percent had either diabetes mellitus or a history of gastrointestinal or genitourinary surgery. Nearly half (48 out of 102 episodes) received aminoglycoside monotherapy, while 25% received an anti-pseudomonal cephalosporin. The 2-year cumulative survival free from failure was 69% (95% CI, 56%-82%). Patients treated with resection arthroplasty, two-stage exchange, and debridement with implant retention had a 2-year cumulative survival free from failure of 80% (95% CI, 66%-95%), 83% (95% CI, 60%-100%), and 26% (95% CI, 23%-29%) respectively (P=0.0001). Conclusions: PS PJI’s are associated with a high failure rate. Patients treated with debridement and implant retention had a worse outcome.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423557/pdf/jbjiv01p0025.pdf

December 27, 2019 at 3:48 pm

APSIC GUIDELINES for the prevention of SSI.  

Antimicrob Resist Infect Control. November 12, 2019 V.8 P.174.

Ling ML, Apisarnthanarak A, Abbas A, et al.

Background

The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices.

Method

The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.

Results

It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions.

Conclusions

Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852795/pdf/13756_2019_Article_638.pdf

December 13, 2019 at 7:15 am

Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial

LANCET June 15, 2019 V.393 N.10.189 P.2395–2403

Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial

Background

Risk factors for maternal infection are clearly recognised, including caesarean section and operative vaginal birth. Antibiotic prophylaxis at caesarean section is widely recommended because there is clear systematic review evidence that it reduces incidence of maternal infection. Current WHO guidelines do not recommend routine antibiotic prophylaxis for women undergoing operative vaginal birth because of insufficient evidence of effectiveness. We aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth.

Methods

In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome was confirmed or suspected maternal infection within 6 weeks of delivery defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. We did an intention-to-treat analysis. This trial is registered with ISRCTN, number 11166984, and is closed to accrual.

Findings

Between March 13, 2016, and June 13, 2018, 3427 women were randomly assigned to treatment: 1719 to amoxicillin and clavulanic acid, and 1708 to placebo. Seven women withdrew, leaving 1715 in the amoxicillin and clavulanic acid group and 1705 in the placebo groups. Primary outcome data were missing for 195 (6%) women. Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection (180 [11%] of 1619) than women allocated to placebo (306 [19%] of 1606; risk ratio 0·58, 95% CI 0·49–0·69; p<0·0001). One woman in the placebo group reported a skin rash and two women in the amoxicillin and clavulanic acid reported other allergic reactions, one of which was reported as a serious adverse event. Two other serious adverse events were reported, neither was considered causally related to the treatment.

Interpretation

This trial shows benefit of a single dose of prophylactic antibiotic after operative vaginal birth and guidance from WHO and other national organisations should be changed to reflect this.

Funding

NIHR Health Technology Assessment programme.

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30773-1/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930773-1

November 8, 2019 at 8:09 pm

Vertebral osteomyelitis: clinical features and diagnosis.

Clin Microbiol Infect. October 2014 V.20 N.10 P.1055-60. Jun 14.

Eren Gök S1, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, Dokuzoğuz B.

1 Infectious Diseases and Clinical Microbiology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Abstract

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/pdf

September 21, 2019 at 8:09 pm

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study.

Eur J Nucl Med Mol Imaging. May 2018 V.45 N.5 P.798-805.

Kouijzer IJE1,2, Scheper H3, de Rooy JWJ4, Bloem JL5, Janssen MJR4, van den Hoven L6, Hosman AJF7, Visser LG3, Oyen WJG4,8, Bleeker-Rovers CP9, de Geus-Oei LF10,5.

1 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. ilse.kouijzer@radboudumc.nl.

2 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands. ilse.kouijzer@radboudumc.nl.

3 Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

4 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

5 Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

6 Technical Medicine, University of Twente, Enschede, the Netherlands.

7 Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

8 Department of Nuclear Medicine, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.

9 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.

10 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands.

Abstract

PURPOSE:

The aim of this study was to determine the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

METHODS:

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. 18F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

RESULTS:

For 18F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

CONCLUSION:

18F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978906/pdf/259_2017_Article_3912.pdf

September 21, 2019 at 8:07 pm

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

Clin Infect Dis. September 15, 2015 V.61 N.6 e26-46.

Berbari EF1, Kanj SS2, Kowalski TJ3, Darouiche RO4, Widmer AF5, Schmitt SK6, Hendershot EF7, Holtom PD8, Huddleston PM 3rd9, Petermann GW10, Osmon DR11, Infectious Diseases Society of America.

Abstract

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

FULL TEXT

https://academic.oup.com/cid/article/61/6/e26/452579

PDF (CLIC en PDF)

 

– – –

 

Clin Infect Dis. April 1, 2016 V.62 N.7 P.953-4.

LETTER – Vertebral Osteomyelitis Guidelines.

TO THE EDITOR—I congratulate Dr Berbari and colleagues for producing the 2015 guidelines for diagnosis and treatment of vertebral osteomyelitis, despite the lack of controlled trials to guide them [1]. However, the guidelines left out any mention of coccidioidomycosis as an etiology of this infection. More than 25% of patients with disseminated coccidioidomycosis have bone and joint infections, and in adults the axial skeleton is involved in more than half of those cases [2]. Infection may be multifocal in the spine. Although …

FULL TEXT

https://academic.oup.com/cid/article/62/7/953/2462943

PDF (CLIC en PDF)

September 21, 2019 at 8:05 pm

Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis.

BMC Infect Dis. September 17, 2018 V.18 N.1 P.468.

Li YD1, Wong CB2, Tsai TT1, Lai PL1, Niu CC1, Chen LH1, Fu TS3.

Abstract

BACKGROUND:

Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.

METHODS:

This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.

RESULTS:

Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).

CONCLUSIONS:

The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142394/pdf/12879_2018_Article_3377.pdf

September 21, 2019 at 8:02 pm

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